In the interests of clarity, Giles Fraser should exercise the right to reply

There has been much furore over the Giles Fraser article on depression, or against drug companies, depending on how you read it. The overwhelming reaction has been a queue of people lining up to inform Giles he really doesn’t understand depression if he thinks it is having a shit job or shit home life, many of which have been collated here.

Equally, there have been others that have come out in support of Giles and claim that everyone is missing the point, which is that medicalising normal human emotions is a bad thing. Now undoubtedly this is true, and you’d struggle to find a single person arguing against that, but – to turn the tables for a second – those people are missing the point. Nobody is arguing against the danger of prescribing strong psychoactive drugs to people that are not in need, the reaction has been against a perceived dismissal of depression as a quasi-medical condition, or the attempt to conflate depression with normal human emotions.

Seemingly Giles has been misinterpreted, as the main thrust of his argument was against drug companies, and he did not equate unhappiness with depression. Undoubtedly it was clear that Giles was not purposefully intending to victimise sufferers of depression, and as I have said in a previous post the underlying message that the rush to medicate sets a dangerous precedent is one that few would challenge.

However, having read, re-read, analysed and discussed the article with others that insist the article is not about depression but rather misdiagnosing sadness, I have to confess I am still unable to see where the distinction is drawn. Being a religious man, you would hope to believe that Giles has a benevolent and charitable nature and therefore would not have dreamed of intentionally caused such offence, so it would seem churlish not to take him at his word. However, there is still the rather awkward situation of the article itself.

It starts with a story of a misspent youth and natural adolescent exuberance, that would now (apparently) undoubtedly be medicalised and misdiagnosed as ADHD. Now, at the risk of misinterpreting Giles once again, it appears that he views ADHD as a sort of sham condition that is little more than rampant hormones and growing up:

For, since the mid 80s, society has decided that adolescent trouble-making is some sort of medical condition. We have given it a scientific-sounding classification, ADHD, securing a sense that a messy adolescence is pathological, some sort of chemical imbalance. Thus the scientists are called in to reinforce generally conservative norms of appropriate behaviour.

Perhaps I am putting words in his mouth, or reading this the wrong way, but from where I’m sitting it sounds like he’s dismissing ADHD as essentially “being a teenager”. Now, I don’t know if ADHD is a real condition or not, I’m neither a doctor nor a scientist and as a complete lay-person my opinion on the matter is meaningless and irrelevant. What I do know is there are professionals that believe ADHD is a genuine condition, who are far more skilled and qualified than me to speak on the matter, and therefore in these situations I find it is best to defer to people that know what they are talking about. That’s not to say there is no place for healthy scepticism or that every authority should be accepted in blind faith, and it’s not to dismiss the notion that there are probably countless cases of misdiagnosis. However, Giles appears to take the view that ADHD is not a real thing.

Whether this is open for interpretation is up for debate, however what is absolutely irrefutable is that at no point does Giles accept or recognise that ADHD is a genuine condition that can benefit from medication.

So this sets the tone for the start of the piece; the reader has been primed with an example of how normal behaviour can be medicalised and that any behaviour that does not conform to strict conservative norms is now treated with a pill, regardless of how (in the grand scheme of things) normal and natural it really is. Naughty kids are being turned into a condition and therefore a commodity. There is no real sense of nuance here, the point is not tempered (as it could easily be) by stating that the over-medication of boisterous children that do not actually have the condition is distracting attention and treatment away from those that genuinely need it. It simply makes the point that we are unnecessarily turning normal behaviour into a pathological condition, and that prescribing drugs as the answer has become dangerously out of control.

Moving on Giles then takes the view (and this is probably one of the most contentious parts):

The same thing has happened with depression and drugs like Prozac; though calling it depression is already to classify a particular kind of experience as something quasi-medical, thus leading one to think in terms of medical treatment.

For those people, Giles himself included, that claim there is no attempt to equate sadness with depression, or that Giles clearly states there is a difference between a normal range of human emotions and a genuine medical condition, this becomes problematic:

“The same thing has happened with depression” – the ‘thing’ apparently being that we have taken perfectly normal behaviour and created a pseudo-condition to suit it.

“Though calling it depression is already to classify a particular kind of experience as quasi-medical”. Calling ‘it’ depression? Calling what depression? The subject is clearly still depression, so essentially this can be paraphrased as:

Calling depression “depression” is classifying it as quasi-medical

Which somewhat undermines the view that there is a difference between a genuine medical condition – which does need medication, and a quasi-medical condition – which does not.

He goes on to say:

Sometimes I am just sad. Sometimes pissed off. Sometimes smothered in darkness. But we often lump all these experiences together simply because pharmaceutical companies have developed a certain sort of treatment.

This is probably as close as it comes in terms of Giles explicitly making the distinction between ordinary sadness and depression, but even this stops short of accepting that for many depressed people drugs represent a relief and a reprieve. The phrase “smothered in darkness” seems as though Giles is alluding to his own struggle with depression and how this differs from being sad or pissed off, but fundamentally it just fails to ring true.

I’m sorry Giles, I listen to Radio 4, I’ve heard you speak – no doubt you’re aware of the expression “takes one to know one” – and at the risk of pooh-poohing your experiences, you’ve not been depressed – of this I am certain. Even the idea that depression can be a temporary fugue from which one can recover is indicative of an outsider’s view. Depression is not a phase you go through, it is not something you get over – being a depressive is like being an alcoholic; even those who have not touched a drop in decades still describe themselves as ‘recovering’, and likewise for a depressed person that is not currently feeling rock-bottom, the spectre looms over them still. Listening to your contributions on The Moral Maze you appear to have an obsession with the idea that it is societal pressure placing unrealistic demands on people to be happy, and that this obsession with people being happy is actually marginalising those that are sad and isolating them, thus making the situation worse.

Perhaps, if we are discussing people that are just sad, this is true. But to make such facile points as “the fascism of the smiley face” when talking about people that suffer from a genuine condition, which you seem unable to acknowledge, identify or distinguish as different from being a bit down, then I’m afraid the problem here lies not in the ear of the listener or the eye of the beholder, but in your own inability to articulate yourself in an unambiguous fashion. You say that you are not equating unhappiness with depression, yet everything else that you say and the attitudes you demonstrate belie this.

The article continues:

We have found the solution, now let’s make the problem fit the solution we have available. It’s a form of reverse engineering.

And goes on to say:

Thus we are encouraged to think of our problems in terms of the lucrative solutions to problems we didn’t know we had. In this way, the pharmaceutical companies are responsible for the very conditions they propose to alleviate

Even taken on their own merit, devoid of the context of what follows, these quotes suggest that anti-depressants are a solution to pseudo-problems, and that pharmaceutical companies are guilty of manipulating and then monetising human emotions to suit their own nefarious needs. Far be it from me to defend Big Pharma, but there is no attempt to balance these assertions with the suggestion that for thousands or even millions of people, anti-depressants provide an essential role in their lives that allow them to function or even survive. There is no suggestion that anti-depressants have a positive impact on anyone’s life, nor that there are situations and circumstances where they are appropriate. Giles could have said this, he could have easily paused at this point and clarified his position by saying something along the lines of “Of course, for people suffering from genuine depression, anti-depressants are the answer and have an important role to play”.

But he doesn’t. He doesn’t say it anywhere within the article. There is not even the merest hint of acceptance that – in the right circumstances – anti-depressants can literally be the difference between life and death.

Indeed the article continues, and Giles doubles-down on his stance:

Forget the fact that some people are miserable because they are struggling on zero-hours contracts, or have lost their partner or have been watching the news too much – if we translate misery into some sort of chemical imbalance then someone can make big money out of it. But unhappiness is often a perfectly proper response to the state of the world.

Perhaps it is too subtle, or perhaps swathes of people are just too biased or not intelligent enough to read between the lines and discern the real message, but this does not appear to portray the wider connotations that Giles would like to attribute to what he has said. Had this been preceded with a clear distinction between sadness and depression, had Giles elaborated on his supposed point that sadness and depression are not the same thing, then this could probably stand as one of the least controversial elements. Taken at face value, it’s a fair point – unhappiness often is a perfectly proper response to the state of the world, and in those circumstances prescribing strong psychoactive drugs is undoubtedly dangerous.

However, at no point has Giles shown any indication of understanding that depression has zero correlation with the state of one’s life or circumstance. In fact the opposite appears to be true and he appears unable to see depression and sadness as discrete things that are completely unrelated. The overwhelming impression he gives is of a well-intentioned man that firmly believes pharmaceutical companies are taking advantage of people at their most vulnerable, and locking them into a self-defeating cycle of medication and unrealistic expectations.

At no point does he recognise that for some people, the drugs do work, and have continued to do so for several years. Claiming to question why all the different forms of darkness get turned into a medical condition has the air of revisionism, as the obvious (at least to the majority of readers) interpretation of the article is that depression is not a medical condition, but rather “quasi-medical”.

The final paragraph has been heralded by some as the point the masses are missing, in which Giles makes clear the difference between those who genuinely require chemical help, and those who have it thrust upon them. I have to say, I’m unable to see it (though willing to continue trying). Here it is verbatim:

Yes, there are some for whom happiness can be reclaimed by doing a bit more exercise or being more sociable. This sounds healthier than pills. But for those for whom these are not solutions, let’s not make it worse by insisting upon the compulsory happiness of the smiley face. For, like the drugs, this can be just another way of shutting people up.

The opening line suggest some people that are feeling low can benefit from exercising and socialising. A fair point, many people that are feeling “a bit down in the dumps” probably would benefit from these things. It could however be easily misconstrued – are we taking ‘happiness’ to be the antonym of sadness, or depression? If sadness, then there is little wrong with the statement, but if the message is that depressed people could benefit from getting out more (as some have interpreted it) then not only is it inaccurate, it is ignorant, insensitive and offensive.

“This sounds healthier than pills” – of course it does. Most things would sound healthier than taking pills. If you suffered from high blood pressure then “don’t eat bacon and do some exercise” would sound healthier than “you’ve got to take three of these a day for the rest of your life” – but depending on the circumstances what sounds healthier might be what actually kills you. Again the underlying message still reads as “pills are bad, m’kay”.

“But for those for whom these are not solutions” – ‘these’ being what? From my own reading, and evidently many others, this could be and is being interpreted as meaning exercise and socialising, not taking anti-depressants, an interpretation that is supported by the continuation “let’s not make it worse by insisting on the compulsory happiness of the smiley face. For, like the drugs, this can be just another way of shutting people up.”

Consistently, throughout the article (and in the Moral Maze discussion), the application of anti-depressants is portrayed as a medium of oppression, a manifestation of society’s overbearing desire to sweep unhappiness under the carpet and put on a good show for all those at home. Giles appears to recognise a slow descent into a brave new world in which unhappiness is seen as some form of moral deviancy and societal expectations are placed before the needs of vulnerable people. For some, perhaps this is true – undoubtedly the prescribing of strong psychoactive drugs to a person not in need could be a path into the heart of darkness, a horrific abuse that could result in making things worse.

However, it completely fails to recognise the liberating effect that these drugs can have. For someone suffering from depression, exercising and socialising might be a distant dream, but with the benefit of anti-depressants they might be enabled to do these things; they might have the energy to get out of bed and keep going, they might have the courage to step outside the front door.

As I have already stated, the idea that we run the risk of misdiagnosing people that are feeling sad as being depressed is uncontroversial, and the opinion that dishing out drugs indiscriminately is dangerous is one that no sensible person could take issue with. However, this is not the bone of contention – the overwhelming response has been a reaction to the implication that depression is little more than a natural response to life events. Perhaps this is a misinterpretation and perhaps the reaction is peculiar – but with Giles displaying such a lack of clarity it is hardly surprising. Indeed, for many depressives, his response and that of others will serve as a reminder of that all-too-common accusation “oh, you’re so sensitive – I didn’t mean it like that!”

If we are to take Giles at his word and take his protestations at face value, then superficially it seems the article was not intended to cause the offence that it has – and I’m sure that it certainly wasn’t intended to be overtly offensive. Nevertheless the justifications seem trite and hollow. For a man who recognises the difference between sadness and depression he is spectacularly poor at communicating this – the distinction between the two is notably absent in his treatment of the subject and he seems fixated on the idea that ‘happy pills’ serve only the profits of pharmaceutical companies.

The brief assertion “did not equate unhappiness with depression” does little to dispel the obvious conclusion that Giles cannot recognise the difference between feeling shit about life and feeling depressed. For all involved, a more comprehensive response may serve in the best interest and help continue to bring this thorny issue to a wider audience.